The Caregiver Advise, Record, and Enable (CARE) Act requires hospitals to give inpatients the opportunity to formally identify a caregiver, such as a friend or relative, who can provide assistance with aftercare following discharge.
The act has been adopted by more than 30 states and the District of Columbia. When it became effective in the state of New York in 2016, the New York State Department of Health issued an advisory to all hospital CEOs about the need to comply. The letter stated that “The New York State Department of Health expects hospitals to develop a policy and procedure to implement the requirements of the CARE Act.”
“Patients are not required to designate caregivers, and caregivers are not obligated to perform after-care tasks for patients. The patient must consent to disclose the patient’s health information to the caregiver if the patient wants to designate a caregiver,” the letter stated. “If the patient does designate a CARE Act caregiver, the hospital must include the name and contact information of the caregiver in the patient’s discharge plan.”
The Department of Health explained that the hospitals must attempt to notify the caregiver of the patient’s transfer to another healthcare facility, and it must attempt to contact the caregiver prior to a patient’s discharge to his or her residence so that the caregiver can provide after-care assistance in accordance with the hospital’s instruction to the caregiver.
“The hospital as soon as possible prior (and if possible, 24 hours prior) to the patient’s discharge must consult with the identified caregiver along with the patient regarding the patient’s after-care needs at his or her residence,” the letter said. “The hospital must offer caregivers instruction in all after-care tasks, taking into account the capabilities and limitations of the caregiver. Instruction to the caregiver is only required for patients being discharged to their homes, not patients being discharged to other healthcare facilities.”
The health department also stipulated the following requirements:
- A demonstration of the after-care tasks. The demonstration may be performed live by a member of the hospital’s workforce authorized to perform the after-care task, or it may be a recorded demonstration.
- After the patient and the caregiver have been given an opportunity to ask questions about the after-care tasks, questions will be answered.
- The hospital must document in the medical record that the instructions were provided to the caregiver.
The letter clarified that instructions to the CARE Act caregiver would not negate the need for home healthcare or other services, and patients must still be assessed for the need for healthcare services as part of the discharge plan.